DIAGNOSIS AND OPERATION FOR ANOMALOUS CIRCUMFLEX CORONARY-ARTERY

Background. Origin of the left circumflex coronary artery from the rig ht sinus of Valsalva is the most common anatomic variation of the coro nary artery circulation. However, there are few reports about the oper ative approach to this anomalous vessel. Methods. Forty patients havin g this anomaly were identified from 10,216 adult cardiac catheterizati on procedures. Forty percent of the anomalous circumflex coronary arte ries (ACCAs) had critical atherosclerotic lesions. Eighty cases needed bypass grafting. Results. For diagnosis of ACCA, the aortic root sign was positive in 94.9% of the diagnosed patients and the nonperfused m yocardium sign was found in 92.5%. Eighty percent of ACCAs were larger than 2 mm in radiographic diameter before their passage into the atri oventricular groove. However, after emerging from the atrioventricular groove, 70% measured less than 1.5 mm. Consequently, a technique was developed to bypass the proximal ACCA and was used in 2 cases. Six oth er patients with more distal disease and larger vessels underwent conv entional bypass grafting. Conclusions. The aortic root sign and nonper fused myocardium are useful in diagnosing ACCA. The ACCA is usually to o small for use of the conventional graft technique. Therefore, a tech nique was developed to graft more proximally and was applied successfu lly in 2 cases. (C) 1997 by The Society of Thoracic Surgeons.